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Crohn's Disease Forum » Treatment » Low Dose Naltrexone » LDN with Methotrexate and Anti TNFa drugs


08-18-2013, 02:24 AM   #1
Crohn2357
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LDN with Methotrexate and Anti TNFa drugs

Hello, I'm considering to use LDN but I am now using Methotrexate and Cimzia for my crohn's. I can not find clear informations about using LDN with immunosuppressants. If I do that(LDN+Methotrexate+Cimzia), can LDN works in its normal way or not? Also, can Methotrexate and Cimzia works in its normal way too? Can they cancel or make useless each other?
Thank you for help.
08-18-2013, 03:12 PM   #2
Jennifer
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I know that medications like 6MP, Imuran etc can be used with biologics like Humira, Remicade, Cimzia etc and with Methotrexate. Even steroids can be added to the mix. There are many different combination therapies out there however I don't know a lot about LDN so I'm going to tag Jmrogers4, JDTM, and ctrl z to see if they can provide more information for you.
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Diagnosis: Crohn's in 1991 at age 9
Surgeries: 1 Small Bowel Resection in 1999; Central IV in 1991-92
Meds for CD: 6MP 50mg
Things I take: Tenormin 25mg (PVCs and Tachycardia), Junel, Tylenol 3, Omeprazole 20mg 2/day, Klonopin 1mg 2/day (anxiety), Restoril 15mg (insomnia), Claritin 20mg
Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
08-18-2013, 05:51 PM   #3
Crohn2357
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Thank you, I really need this information. I asked this question in another platforms, forums and also e-mailed to pharmacies, persons too but I didn't get any info at all.
Thank you very much.
08-18-2013, 07:11 PM   #4
Jmrogers4
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I know you can use LDN with Imuran and 6MP, I would imagine MTX would fall under the same category. My son was supposed to take his Imuran along with LDN for the first 3-4 months then stop the Imuran.
I don't really know about the Cimzia or other biologics. There was a poll done on here a while back, not many answers but one person was using biologics along with LDN
http://www.crohnsforum.com/showthread.php?t=45479.
Sorry I missed your post earlier, haven't been able to check in here as much last week or so my crohnie son just started high school last week and my other son will be heading off to school in a week so trying to get all that last minute stuff done.
If you hear any other answers back I would be curious to hear what the answer is
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Jacqui

Mom to Jack (18) dx Crohn's 2/2010
Vitamin D -2000mg
Remicade - started 1/9/14; 7.5ml/kg every 6 weeks
Centrum for Him teen multivitamin
Past meds: Imuran/Azathioprine; allopurinol; methotrexate; LDN; Prednisone; Apriso; Pentasa; EEN

Husband dx Crohn's 3/1993
currently none due to liver issues
08-19-2013, 03:26 AM   #5
Crohn2357
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I really need to learn that can someone use LDN with Anti TNF drugs. This is really important for me.
08-19-2013, 03:58 AM   #6
Kev
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Wish I could help. Only drug I know of is pred. You can take LDN with up to 10mg of it.
Perhaps someone has an e-mail address for Dr Jill Smith, or one of her peers. They might know.
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KEV

Dx'd July, 2006
Meds: Flagyl, Cipro, Pred, AZA.. to no effect
Low Dose Naltrexone Nov 2007 - May 2014
Remicade June 17th, 2014
08-19-2013, 09:24 AM   #7
JDTM
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Sorry Crohn2357, I wish I could help but I'm not sure, as I haven't had firsthand experience with any biologics yet. However, I'm under the distinct impression that the main thing to watch out for is using LDN and opiate-type drugs at the same time -- this is considered to be a bad idea, as LDN is an opioid inhibitor. I did a quick search and found some anecdotal stories from a few people who had been on both LDN and biologics simultaneously and did not experience any side-effects from the combination of the two.

I guess this isn't really a concrete answer, but I hope it helps somewhat.
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Hi, I'm Jesse!

Current meds:
Lialda (4.8g)
fluoxetine (40mg)
naltrexone (4.5mg)

Previous meds:
Dexilant (too pricey!), Xifaxan (short course), budesonide (tapered off), Pentasa (had to switch in January 2016), omeprazole

Supplements:
multivitamin
2000IU vitamin D-3

Diagnosis:
gastritis & duodenal ulcers, August 2011
Mild Crohn's in terminal ileum, February 2012
5cm of narrowing w/ no signs of active inflammation, May 2014
08-19-2013, 02:04 PM   #8
Crohn2357
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Hello again. To clarify this topic, I sent e-mail to Dr. Jill Smith and Dr. Ian Zagon.
Dr. Jill Smith said in their prior publications naltrexone was use with thiopurines, methotrexate, and aminosalicylates. There have not been any studies with anti-TNF drugs. And also Dr. Smith said Naltrexone is an opioid receptor antagonist meaning its mechanism of action is through the blockade of opioid receptors. Cimzia is a monoclonal antibody that works by inhibiting the actions of TNF-a. These are two different mechanisms.
Dr. Zagon said to me LDN and these other drugs should not be a problem. Should be fine.
I am greatful and more satisfied now.
Regards.

Edit: I also have an e-mail now from Skip's pharmacy and they said: Using LDN with immunosupressants is not recommended. It will not
inhibit the mechanism of the immunosupressants, based on the way LDN
works, we don't know how effective the naltrexone would be in optimizing
immune system functioning.
08-19-2013, 04:31 PM   #9
Kev
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OK, the response from Skips has me confused. Anyone else? It seems to contradict, or perhaps.. contra-indicate what Dr's Smith and Zagon are saying. Or does it elaborate?

I'm going to demonstrate to the world my ignorance. Please, anyone who can clarify this one way or the other... please jump in... add notes.. make corrections, what have you. Here is my 'laymans' understanding of how LDN works. It is an opoid receptor blocker... so folks with alcohol/opiate dependancy.. if they take Naltrexone in typical doses... simply don't get their high. In low dose, the opiate blocking tricks the brain into thinking that the amount of... dopamine (if it was in another persons head, would it be called dopayours???) ... OK, couldn't resist that... crazy, don't you know.. dopamine may not be the brain chemical that this trickery releases in over abundance. This is what I "ASSume" is the desired rebound effect... and this stimulates the bodys immune system to fight the disease. That is my very limited understanding, and I may have it all wrong... please feel free to correct me, educate me.. I won't take offence. (be gentle). Thing is... if that is the way it works, AND you are suppressing your immune response, it might be accurate to say the immuno suppressors won't affect the LDN, or vice versa... BUT... if it is an 'positive, beneficial immune response' this rebound effect generates, any weakening of the immuno response would seem to suggest it would slow any healing.

That is my understanding (more likely mis-understanding) of how it works. If I am close to being right (miracles do happen) then that would explain why Skips info goes against what the docs are saying. I guess one key question to ask is... why muddy the waters by mixing N matching various drugs. One of the key reasons to go LDN is to avoid/limit side effects. If you are taking it with these other drugs, you are still playing the odds with their side effects. So, you are adding the risk of combining multiple drugs that have not be tested together... and not getting the prime benefit out of going with LDN.

If this combo works, which drug did it? If it fails, which drug do you blame. It seems to me like a lose/lose scenario.
08-19-2013, 04:57 PM   #10
Crohn2357
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If this combo works, which drug did it? If it fails, which drug do you blame. It seems to me like a lose/lose scenario.
Kev, I think this is a very important problem in this case.
08-19-2013, 05:21 PM   #11
Kev
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Why? If the other drugs are working, then there is no need to look into LDN. If not... then look at your other options. Including LDN. If you combo them, and nothing works, does that mean LDN won't work for you, or is it because you took it in combo with the others. As I've repeatedly said on this forum; if whatever someone is currently taking is working... why on Earth rock the boat. Stick with whatever is working. If the fears of the potential side effects is giving someone pause for thought... combining LDN with it will not erradicate or lessen those potential side effects. If whatever regimen someone is currently using isn't working... then weigh the pros and cons of all feasible options.

I have zero medical training. My background is computer science and electronic engineering. In problem solving, (or in most other experimentation) you make one change, observe the reaction, determine whether it has improved/worsened the situation. Going with multiple, concurrent meds... you can't determine which caused any improvement, which caused any problems... or what may/can/will happen if you mix and match meds that haven't been clinically tested/evaluated together. Just my thoughts...
08-20-2013, 01:45 AM   #12
Crohn2357
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In this topic, I said I'm using methotrexate and Cimzia together but It was just a supposition. I will start Cimzia within one month. Now, I'm only using methotrexate injections.
There are three option for me.
1- I can stop taking methotrexate and only take LDN
2- I will try Cimzia + methotrexate and will not use LDN
3- I can take three of them.

The thing is, I used Remicade and Humira and they did not work well for me. I don't have good expectations about Cimzia but I will give it a try and see what happens.
08-20-2013, 04:11 AM   #13
Kev
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Again, if the combo of the two (Cimzia N Metho) work, why add LDN? The reason I say this... OK, it has been said that LDN can be used with up to 10 mg of pred, but not more. Why not more? That raises a concern (at least a question) for me. I do not know the mechanics of how Cimzia or Metho work. My limited knowledge of pred is that it is an immuno suppressor. Works great, but because of the potential side effects, it isn't a viable long term solution.

If Cimzia or Metho are (one a biologic, the other is a form of chemo... that is the extent of my knowledge) used to also suppress the immune system, it might slow any benefits of taking LDN, and LDN takes long enough to work as it is. And, I would be very wary of the following potential scenarios...

Someone takes all three drugs... and there is a reaction. Wind up in the ER. Docs don't know which drug caused the problem... what do they do? Take the patient off all three. Or... there is an issue, but the combo makes the issue worse. Or, perhaps even worst of all... one of the combo masks an issue... preventing it from being discovered in time.

I understand the desire to throw everything you can at this disease. Been there... but usually doctors try one drug at a time, wait and see what happens, and keep others up their sleeve in case. If combining groups of different drugs to try on this were the safest method, more doctors would employ it. It does happen, but I think doctors use it in exceptional circumstances... but, again, I'm not a doctor, absolutely no qualifications.
08-20-2013, 06:00 AM   #14
Crohn2357
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According to my doctor I'm primary non response to anti TNF drugs and in my case, the possibility of seeing good result from Cimzia is very low. And I'm in bad flare for a long time. I thought maybe I start using LDN right now and during this time or so LDN maybe kicks in. But there is a problem here. Although succes chance of Cimzia is very low but If my crohn's get better with three of them, I can not know which one is working. So, like I said, I will give a try to Cimzia, Methotrexate combo together and see what happens. I won't use LDN in this time. If this combo won't work, I will stop all medications and try LDN. If this happens, I hope my Crohns flare will not be too bad to wait LDN's working.

Note: I also received and e-mail right now from The LDNscience Team and they are saying:
Unfortunately there is no clarity about this question.
At best one can say that it is not known to be harmful to combine them but whether the LDN will be less effective with this combination is not known.
08-20-2013, 02:54 PM   #15
Jennifer
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I really need to learn that can someone use LDN with Anti TNF drugs. This is really important for me.
Judith or David do you know anything more about LDN and biologics use? Can they be used together? Does one make the other less effective (is that even possible)? Thank you for any input.
08-20-2013, 03:44 PM   #16
Kev
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My thoughts are that your decision to go with the Metho/Cimzia combo is a sound one. If that fails... although there is no reason to expect it will... perhaps you could try pred to stop the flare... then when you taper down to 10mg, add the LDN. There just hasn't been enough research, and LDN is in such limited use, that I don't think there is a sound knowledge base to formulate an opinion on combining LDN with the biologics. Your other option is to play guinea pig yourself... but that is a terrible risk to assume. Much safer to try Metho with Cimzia. And it avoids (for the present) the hassle of finding a doctor who will prescribe it.. and a pharmacy that knows how to properly compound it too.
08-20-2013, 08:07 PM   #17
Crohn2357
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I made my decision yesterday, thank you all for interest. Topic can be ended.
08-29-2013, 12:49 PM   #18
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I made my decision yesterday, thank you all for interest. Topic can be ended.
What was your final decision?
08-30-2013, 12:16 AM   #19
Crohn2357
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David, I stopped taking methotrexate and I will not try a new anti TNF drug. I'm waiting for my LDN from pharmacy. Within one week, I will have LDN and start using it. Also, when I stopped immunosupressants I started salofalk tablets and surprisingly, it is slowing my disease more than immunosupressants but as you guess it is not close enough. It is just giving me less BM, less pain and less blood. This is necessary to wait LDNs kicks in.
08-30-2013, 03:42 AM   #20
Kev
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I took Salofalk (4 G) every day for 7 years. Unlike yourself, I never noticed it helped in any way. However, it never interfered with my LDN. I have been off of it (Salofalk) since last December, and my condition did not deteriorate in any way. This disease can be so different... what works for some does not work for others. Good luck with the LDN.
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